<include file="public@head" />
       <div class='main'>
        <div class="row">
            <include file="public@left" />
            <div class="col-lg-9 col-md-9 rightdiv">
                <div id="news1">
                    <h5 class="contit">我要加盟<span class="f-right">当前位置：<a href="/">首页</a>/我要加盟</span><span class="bgline"></span></h5>
                    <div class="buildbox">
                        <h4>填写信息</h4>
                        <div class="buildform">
                            <form role="form" id="joinform" method="post" action="{:url('portal/join/apply')}">                           
                            <div class="form-group">
                                <label for="name" class="control-label">姓名<span>*</span></label>
                                <input type="text" class="form-control" name="name" minlength="2" autocomplete="off" required>
                            </div>
                            <div class="form-group">
                                <label for="kind" class="control-label">性别<span>*</span></label>
                                <select class="form-control" name="sex" required> 
                                    <option value="">请选择</option>
                                    <option value="1">男</option>
                                    <option value="2">女</option>
                                </select>
                            </div>
                            <div class="form-group">
                                <label for="phone" class="control-label">电话<span>*</span></label>
                                <input type="number" class="form-control"  name="mobile" iphone="true" required>
                            </div>
                            <div class="form-group">
                                <label for="title" class="control-label">邮箱<span>*</span></label>
                                <input type="email" class="form-control" name="email" required>
                            </div>
                            <div class="form-group">
                                <label for="address " class="control-label">所在公司<span>*</span></label>
                                <input type="text" class="form-control" name="company" minlength="4" required>
                            </div>
                            <div class="form-group">
                                <label for="lever" class="control-label">加盟级别<span>*</span></label>
                                <select class="form-control" name="level" required> 
                                    <option value="">请选择</option>
                                    <option value="2">高级</option>
                                    <option value="1">中级</option>
                                </select>
                            </div>
                            <h4 class="formtit">邮寄地址</h4>
                            <div class="form-group">
                                <label for="shen" class="control-label">省份<span>*</span></label>
                                <input type="text" class="form-control"  name="province" required>
                            </div>
                            <div class="form-group">
                                <label for="shi" class="control-label">城市<span>*</span></label>
                                <input type="text" class="form-control" name="city" required>
                            </div>
                            <div class="form-group">
                                <label for="qu" class="control-label ">路-街-弄-区</label>
                                <input type="text" class="form-control" name="address" required>
                            </div>
                            <div class="form-group">
                                <label for="zipcode" class="control-label">邮编</label>
                                <input type="text" class="form-control " name="postcode" required>
                            </div>                                  
                            <div class="form-group">
                                <button type="submit" class="btn sbtn">提交资料</button>
                            </div>
                            </form>
                        </div>
					</div>
                </div>
            </div>
        </div>
    </div>
    
<include file="public@footer" />